Therapeutic Action of Iodoform

542 Progress of the Medical Sciences. [Oct.

some time, anil suffering from want of mental activity, etc., in June, 187 7, marked
depression set in, accompanied by delusions of persecution and hallucinations of
various senses. Continuous sleeplessness being also present, his medical attend¬
ant prescribed bromide of potassium in doses from SO to 90 grains per diem.
The patient, however, took the drug irregularly; on some days he only took 45
grains, but on others as much as 150 and 180 grains; within four months he con¬
sumed about 35 ounces of the drug, giving an average of over 130 grains daily.
During this time his condition became rapidly worse, he became stupid and for¬
getful, his features lost their expression, and his bearing was careless and unsteady.
His speech was heavy, though not exactly stammering, muscular tremor super¬
vened, and the patient’s gait became staggering. In this condition, he was brought
to Dr. lioettger at the Carlsfeld Asylum as a case of general progressive paralysis.
The first impression made by the patient seemed to justify this diagnosis. Besides
the symptoms mentioned above, it was noted that the pupils were very unequal
(the left being the smaller), and both reacted very slowly; the tongue was slightly
coated, tremor of its muscular bundles was observed, and it was inclined to the
left side ; speech was slow, heavy, and interrupted by long pauses, as if the patient
had a difficulty in thinking of his words. The pulse was small and faint, the sur¬
face-temperature low; his whole appearance indicated mental and physical decay.
The entire body inclined markedly towards the left side, as is frequently the case
in paralytic patients. The peculiar faint sweet smell of the breath, already noticed
as occurring in bromism, was very marked. The first diagnosis made was that of
paralytic dementia.

At first, small doses of the bromide were given, and the patient rapidly became
more stupid and unsteady in his gait; he once fell while walking and injured his
forehead, when it was noted that sensibility to pain was greatly diminished. After
a very few days, owing to loss of appetite and strong fetor of the breath, the bro¬
mide of potassium was discontinued, quinine and iron being prescribed instead;
the immediate improvement in the patient’s condition, combined with other con¬
siderations, very soon made it clear that the case was one of bromism. The
patient had to be fed with a spoon, and took only liquid and soft food for some¬
time ; the stupidity continued for about a month; after that time Herr 11. became
gradually more active; his bearing was more upright, and his countenance showed
more expression; his gait also became more sure, and the fetor of his breath dis¬
appeared. Appetite and interest in things in general returned. Memory also
improved, but was quite extinguished for events which had occurred during the
height of the bromism. During the next few months the patient rapidly recov¬
ered, all the paretic symptoms passed away, and lie is now enjoying good mental
and bodily health.— London Medical Record, Aug. 15, 1878.

Therapeutic Action of Iodoform.

Dr. Molhschott ( Wiener Medicin. Wochenschrift , Nos. 24, 25, and 2G,
1878) states that he has used iodoform with good result in the treatment of exu¬
dation into the pleura, pericardium, and peritoneum, and of the acute hydroce¬
phalus of children. He generally applied it in the. form of ointment (1 in 15 of
lard) or with elastic collodion (1 in 15 of collodion). Large glandular swellings
were caused to disappear under the use of the iodized collodion. It was found
useful as a means of assuaging pain in gout, neuralgia, and neuritis. Syphilitic
myocarditis was cured by iodoform inunction, combined with the internal use of
the drug in doses of from three-fourths of a grain to a grain and a half daily.
Iodoform appears to act like digitalis on the heart, increasing the strength and
reducing the frequency of its beats; and was hence used successfully in uncom¬
pensated valve-disease. Its action depends probably on its ready decomposition,

1878.] Materia Medica and Therapeutics. 543

by which the iodine in a nascent state is brought into action on the tissues.—
London Med. Record , Aug. 15, 1878.

Action of Pilocarpin.

Dr. A. Loesch ( Deutches Arclvin. fur Klin. Med., Band xxi., Heft 2 and 3)
found that the subcutaneous injection of 2 centigrammes (0.3 grain) of muriate ol
pilocarpin in dropsical and non-dropsical cases was followed in a period varying
from two to five minutes by diaphoresis and salivation, varying in intensity, but
generally lasting an hour and a half or two hours. The loss of weight was as a
rule from 700 to 900 grammes; in some cases it was twice as much, in others much
less. The internal administration of 4 centigrammes (0.6 grain) was followed at
the end of 23 minutes by an increased secretion which lasted only 15 minutes.
Severe vomiting was sometimes observed ; this unpleasant symptom also follows
the use of jaborandi. Dr. Loesch warns against the use of pilocarpin in cardiac
affections, as its effect on the heart’s action was always considerable. This was in
some cases increased, and sometimes was rendered irregular.

Franked ( Chariti-Annalen , 1878) gives an account of experiments on dogs per¬
formed by him in conjunction with Leyden, from which the conclusion is drawn
that a deleterious action on the heart is not to be expected from the use of the
drug. Doses up to 0.6 grain had but little effect on the frequency' of the pulse
and the arterial pressure, as measured by' the kymograph. When the amount
injected was increased, the frequency' of the pulse was remarkably reduced, even
when both vagi were divided ; but, when once a certain limit had been reached,
there was no further reduction of frequency even under increased doses, provided
that artificial respiration were practised. The injection of small quantities of
atropia at once interrupted the action of the pilocarpin. These drugs thus seem
to be antagonistic in their action on the secretion of sweat.

Dr. Frtinkel relates some cases in which the use of pilocarpin was followed by
beneficial results. In a case of acute nephritis, 25 milligrammes (three-eighths of
a grain) of pilocarpin were injected every day for seven days in succession, then
every second or third day ;. the result was removal of the oedema, and restoration of
the normal secretion of urine. In two analogous cases, recovery followed injec¬
tions made on alternate days for 34 weeks and 14 days respectively. A fourth
case was one of bronchial catarrh with severe cyanosis, oedema, ascites, dyspnoea,
and scanty secretion of urine. Expectant treatment and digitalis were useless ;
treatment by pilocarpin was at once followed by improvement and ultimately by
cure.— Land. Med. Record, Aug. 15, 1878.

Action of Muriate of Pilocarpin in Children.

Dr. Demme, of Bern (Centralzeitung fur Kind.erheilkunde), has administered
muriate of pilocarpin by subcutaneous injection to 33 children. Of these, 18
suffered from desquamative nephritis with dropsy after scarlatina; 3 from nephri¬
tis after diphtheria (without scarlatina) and a high degree of dropsy. In 12
cases, the diseases were dropsy from disease of the valves of the heart, multi-
articular rheumatism, whooping-cough, broncho-pneumonia, and parotitis. The
ages of the children varied from 9 months to twelve years. The dose adminis¬
tered subcutaneously was—up to the end of the second year, 5 milligrammes ( 075
grain); from the second to the sixth year, 7.5 milligrammes to 1 centigramme
(0.11 to 0.15 grain) ; and from the seventh to the twelfth year, 1 centigramme
to a quarter of a gramme.

The injections were well borne, except in two cases; in one of these, vomiting,
hiccup, pallor of the face, and syncope; in the other, yawning, hiccup, and